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1、Unit 10,Diabetes Mellitus,Text A,Prospects for Research in Diabetes Mellitus,Teaching Set-up1.Group Discussion2.Background Knowledge3.Understanding the Text4.Assignment,Group Discussion,1.What do you know about diabetes?2.Why is diabetes viewed as a modern epidemic?3.How to prevent diabetes as early
2、 as possible?,Introduction,Diabetes mellitus is often referred to simply as diabetes(Greek:to pass through).And Mellitus(Latin,meaning honey,is a reference to the sweet taste of the urine.)Diabetes mellitus is a syndrome of disordered metabolism,usually due to a combination of hereditary and environ
3、mental causes,resulting in abnormally high blood sugar levels(hyperglycemia).,Blood glucose levels are controlled by a complex interaction of multiple chemicals and hormones in the body,including the hormone insulin made in the beta cells of the pancreas.Diabetes mellitus refers to the group of dise
4、ases that lead to high blood glucose levels due to defects in either insulin secretion or insulin action in the body.,Diabetes develops due to a diminished production of insulin(in type1)or resistance to its effects(in type2 and gestational).Both lead to hyperglycemia,which largely causes the acute
5、signs of diabetes:excessive urine production,resulting compensatory thirst and increased fluid intake,blurred vision,unexplained weight loss,lethargy,and changes in energy metabolism.,All forms of diabetes have been treatable since insulin became medically available in 1921,but there is no cure.The
6、injections by a syringe,insulin pump,or insulin pen deliver insulin,which is a basic treatment of type1 diabetes.Type2 is managed with a combination of dietary treatment,exercise,medications and insulin supplementation.,Signs and symptoms,The classical triad of diabetes symptoms is polyuria,polydips
7、ia and polyphagia,which are,respectively,frequent urination,increased thirst and consequent increased fluid intake,and increased appetite.Symptoms may develop quite rapidly(weeks or months)in type1 diabetes,particularly in children.However,in type2 diabetes symptoms usually develop much more slowly
8、and may be subtle or completely absent.,Type1 diabetes may also cause a rapid yet significant weight loss(despite normal or even increased eating)and irreducible mental fatigue.All of these symptoms except weight loss can also manifest in type2 diabetes in patients whose diabetes is poorly controlle
9、d.,Overview of the most significant symptoms of diabetes.,Both type 1 and type 2 diabetes share similar symptoms caused by chronically high blood glucose levels.Symptoms of both type 1 and type 2 diabetes include:excessive thirst frequent urination weight loss increased appetite unexplained fatigue
10、slow healing cuts,bruises,and wounds,frequent or lingering infections(e.g.,urinary tract infection)mood swings and irritability blurred vision headache high blood pressure dry and itchy skin tingling,numbness,or burning in hands or feet,Many Patients are asymptomaticSymptoms when present are:Polydip
11、siaPolyphagiaPolyuriaweight lossTirednessRecurrent skin infections,Complications Diabetes and its treatments can cause many complications.Acute complications(hypoglycemia,ketoacidosis,)may occur if the disease is not adequately controlled.Serious long-term complications include cardiovascular diseas
12、e,chronic renal failure,retinal damage(which can lead to blindness),nerve damage(of several kinds),and microvascular damage,which may cause erectile dysfunction and poor wound healing.Poor healing of wounds,particularly of the feet,can lead to gangrene,and possibly to amputation.,Diabetes Complicati
13、ons,Having diabetes increases your risk for many serious complications.,Heart Disease(cardiovascular disease),Diabetes heart,Blindness(retinopathy),NeovascularizationFiber proliferationRetinal detachment,Nerve Damage(neuropathy),Diabeticneuropathy,Kidney Damage(nephropathy),Diabetic kidney,Infection
14、,MACROANGIOPATHY,MICROCIRCULATORY DISTURBANCE,NEUROPATHY,CATARACT,Acromelic gangrene,Foot ulcers are a common complication of the diabetic foot.They allow a portal for infection to occur.,So,what can we do?,Adequate treatment of diabetes,as well as increased emphasis on blood pressure control and li
15、festyle factors(such as not smoking and maintaining a healthy body weight),may improve the risk profile of most of the chronic complications.In the developed world,diabetes is the most significant cause of adult blindness in the non-elderly and the leading cause of non-traumatic amputation in adults
16、,and diabetic nephropathy is the main illness requiring renal dialysis in the United States.,Epidemiology,In 2000,according to the World Health Organization,at least 171 million people worldwide suffer from diabetes,or 2.8%of the population.Its incidence is increasing rapidly,and it is estimated tha
17、t by the year 2030,this number will almost double.Diabetes mellitus occurs throughout the world,but is more common(especially type2)in the more developed countries.The greatest increase in prevalence is,however,expected to occur in Asia and Africa,where most patients will likely be found by 2030.,Th
18、e increase in incidence of diabetes in developing countries follows the trend of urbanization and lifestyle changes,perhaps most importantly a Western-style diet.This has suggested an environmental(i.e.,dietary)effect,but there is little understanding of the mechanism at present,though there is much
19、 speculation,some of it most compellingly presented.,For at least 20 years,diabetes rates in North America have been increasing substantially.In 2008 there were about 24 million people with diabetes in the United States alone,from those 5.7 million people remain undiagnosed.Other 57 million people a
20、re estimated to have pre-diabetes.,Pre-diabetes is a serious medical condition that can be treated.The good news is that people with pre-diabetes can prevent the development of type 2 diabetes by making changes in their diet and increasing their level of physical activity.They may even be able to re
21、turn their blood glucose levels to the normal range.,Prevention,First,Three levels:,1)To the healthy bodies,reduce the risk of getting diabetes.,2)To the diabetics,be sure that“early to find,early to treat,avoid complications as possible as they can”.,3)To the ones with complications,engage to reduc
22、e the mortality.,Second,Prevention,Three more and one less:,Read books,watch TV,and listen to broadcast about diabetes.,Learn more,Eat less,Intake less food and avoid the food with high lipid.No smoking.No drink.,Third,Prevention,Exercise more,Relax more,Examine the blood sugar regularly:,People esp
23、ecially elders should examine the blood sugar regularly whether they have relevant symptoms or not.,Increase the time and amount of exercise to avoid fat.,Keep optimistic,and combine exertion with rest.,Understanding the Text,Para.1cardinal characteristic feature-主要特征 Question:1.What is the main cha
24、racteristic of diabetes mentioned in paragraph one?,Para.2 documentation-证明(血糖水平升高被证明是糖尿病长期并发症的一个 直接原因，这是已经取得的一个重大成就。)DCCT-糖尿病控制和并发症试验 UKPDS-英国前瞻性糖尿病研究 retard-delay 延缓 increment-increase elucidate-explain,insight-viewcoincide(with)-1)同时发生 2)一致;非常相近 to be exactly the same or very similarinsulin pumps
25、-胰岛素泵oral antidiabetic agents-口服抗糖尿病药物 Question:2.What are the long-term complications of diabetes mentioned in this paragraph?,Para.3insulin-dependent diabetes mellitus 胰岛素依赖型糖尿病 juvenile-onset diabetes 青少年发病型糖尿病 pancreatic/pancreas-smolder-to burn slowly without a flame 用文火焖烧;(愤怒等)闷在心里;郁积markers-标
26、志物preclinical phase-prediabetic state-,allow for-devastating-destructive;extremely severepractical-workable;feasibleQuestion:3.What are the basic mechanisms that cause type 1 diabetes?,Para.4administered-appliedforms of insulin-胰岛素构型 couple-vt.(usu.passive)to join or link to 连同,加上e.g.The fog,coupled
27、 with the amount of traffic on the roads,made driving very difficult.islet cell transplantation-胰岛细胞移植regeneration-再生 immortalized-ever lastingcell line-细胞系 predispose to-be susceptible to,Question:4.In the authors opinion,what research areas are necessary for the prevention of type 1 diabetes?,Gene
28、s that predispose to type 1 diabetesEnvironmental factors that trigger the diseaseCellular and molecular causes of the autoimmune destruction,Para.5responsible genes-Question:5.Are there any connections between lifestyle and increasing incidence of type 2 diabetes?Give examples.,Para.6prior to-compe
29、nsatory-代偿的 destined to-注定 decompensated-代偿机能减退的 Question:6.What does this paragraph mainly talk about?,Para.7insulin action cascade-pathway-途径;通路 genetic determinants-遗传决定因素 susceptibility-易感性genetic variation-基因变异 gene expression profile-基因表达图谱 Question:7.What research areas are closely related to
30、 the new targets for pharmacologic intervention?,Para.8-13allele-等位基因 mechanistic-发病机制的 cornerstone-基石 enhancement-改善 genetic predispositions-遗传易感性 adverse effects-副作用 dissect-仔细分析和研究 specific/defined-明确的pharmaceutical agents-药物,Identification of genetic components of types 1 and 2 diabetes:For type
31、 1 diabetes,the basic mechanisms,environmental triggers and their interaction with genetic predispositions;For type 2 diabetes,molecular components involved in insulin signaling,secretion,and cell growth and development,genetic and behavioral contributions to obesity.,Question:8.Can you identify som
32、e diabetes research areas mentioned in“Current Issues”of the text?,Para.14aggressive efforts-积极努力(如果在糖尿病研究广阔前沿的努力是积极的，在具有特殊机遇的领域科研经费不断增长，那么未来的确充满希望。),Para.15cadaveric islet cell transplants-胰岛细胞移植细胞替代的补充来源可取自异种移植，或许是转基因动物，或者创造一个相对取之不尽、用之不竭的功能性胰岛素分泌细胞系。该细胞系将通过从祖细胞生长繁衍大量细胞或通过基因工程永生细胞来形成。Question:9.Are
33、 there any limitations to future cadaveric islet cell transplants?How to solve the problem?,Para.16coupled with-随着对引起自身免疫细胞破坏基本免疫机制的阐明以及为阻断这一过程而进行的特异性靶治疗的发展，I型糖尿病的预防将成为现实。,Para.17in parallel with-(有了这种遗传信息，确认II型糖尿病中造成胰 岛素抵抗和胰岛素分泌受损的细胞缺陷将带来 新药的开发。新的药物将对明确的分子目标有 特效并且相对摆脱了不必要的副反应。)a sound basis for-Que
34、stion:10.What do these two paragraphs mainly talk about?,Para.18preferably-(治疗糖尿病并发症最可靠的方法是通过控制已确诊的糖尿病患者的血糖来预防，而更可取的方法就是预防糖尿病)morbidity/mortalityQuestion:11.What is essential in dealing with diabetic complications according to this paragraph?,Para.19scourge-afflictionQuestion:(para.14-19)12.What do
35、you think of the authors forecasts about diabetes prevention,treatment and cure?Take one example from the text to illustrate your point.13.Do you have predictions of your own about the prevention and treatment of diabetes?Discuss with your partners.,Phrases in the Text,1.cardinal characteristic feat
36、ure2.diabetic retinopathy3.insulin preparations/delivery4.oral antidiabetic agents5.insulin-dependent diabetes mellitus 6.juvenile-onset diabetes7.islet cell transplantation8.cell line,9.metabolic defect10.hyperglycemic diabetic state11.insulin action cascade12.genetic determinants13.gene expression
37、 profiling14.environment triggers15.genetic predispositions16.highly specific immunosuppressive agents,17.adverse effects18.pharmaceutical agents/treatments19.specific targeted treatment20.predisposing diabetes genes21.diabetes susceptibility22.susceptible individuals23.health care delivery system24.therapeutic modalities,Assignment,1.Translate phrases in the text into Chinese2.Finish reading Text B,C and D after class3.Preview unit 11,
